← Diagnosis and Management Guides
Preeclampsia
Key considerations: Eclampsia, HELLP syndrome, Placental abruption
Cannot miss
- Eclampsia
- HELLP syndrome
- Placental abruption
- DIC
Likely diagnoses
- Preeclampsia without severe features
- Preeclampsia with severe features
- Gestational hypertension
- Chronic hypertension
Red flags
- SBP ≥160 or DBP ≥110
- Headache, visual changes
- Epigastric/RUQ pain
- Thrombocytopenia
- Elevated creatinine
- Pulmonary edema
Workup
- history: Gestational age, headache, visual changes, RUQ pain, rapid weight gain/edema; exam: BP (measure correctly), deep tendon reflexes (clonus), RUQ tenderness, edema; labs: CBC with platelets, BMP (creatinine), LFTs (AST/ALT), LDH, uric acid, urine protein/creatinine ratio or 24hr urine; imaging: Ultrasound for fetal growth and amniotic fluid; bedside: Continuous fetal monitoring, NST
Management
- immediate: Magnesium sulfate for seizure prophylaxis (4-6g IV load, 1-2g/hr maintenance); Severe hypertension (≥160/110): IV labetalol, IV hydralazine, or PO nifedipine; general: Delivery is definitive treatment; ≥37 weeks: deliver; <37 weeks with severe features: deliver after stabilization; <37 weeks without severe features: expectant management with close monitoring; Betamethasone if <34 weeks
Disposition
- admit: All preeclampsia patients for monitoring; discharge: Only after delivery and postpartum stabilization — monitor BP for 72hr postpartum; consults: MFM/perinatology, anesthesia for delivery planning
Clinical pearls
- Preeclampsia can present postpartum — up to 6 weeks after delivery
- Magnesium sulfate continues 24-48hr after delivery — eclamptic seizures can occur postpartum
- HELLP can occur without severe hypertension — check labs if RUQ pain or malaise
Source and review
- ACOG Preeclampsia PB 2020. Last reviewed: 2024-11-01